Key result
IVUS safely guides contrast-free transcatheter pulmonary stent-valve implantation with low gradients and no leaks.
Why the study?
Trans-catheter pulmonary stent-valve implantation traditionally requires angiography for positioning, but alternative imaging tools without contrast injections need evaluation.
Case Report (n=5)
No
May offer a contrast-free option for guiding pulmonary stent-valve implantation; hypothesis-generating and requires prospective validation.
Patients with stenosed biologic pulmonary conduits require redo cardiac surgery to prevent severe right ventricular dysfunction. Following the latest trends, the trans-catheter pulmonary stent-valve implantation represents a new fascinating alternative carrying a lower operative risk, compared with the standard open-heart re-intervention. Traditionally, the pulmonary stent valve is positioned off pump, under fluoroscopic control, and requires angiographies. However, alternative tools not requiring contrast injections for the intra-operative cardiac imaging have to be also considered strongly. The usefulness of intravascular ultrasound for the positioning of aortic endoprosthesis has already been proven in previous reports and, following the same principle, we have started to routinely implant balloon-expandable stent valves (Edwards Sapien™ THV) in stenosed pulmonary valve conduits using intravascular ultrasound for the stent-valve positioning without angiography. We describe the intra-operative intravascular imaging technique with technical details.
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Ferrari et al. (2011) conducted a case report in Stenosed biologic pulmonary conduits (n=5). Intravascular ultrasound-guided trans-catheter pulmonary stent-valve implantation was evaluated on Procedural success and hemodynamic outcomes (low gradients and absence of leaks). In five patients, intravascular ultrasound successfully guided trans-catheter pulmonary stent-valve implantation without contrast angiography, resulting in low gradients and no leaks.
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